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General NPI Number Information
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NPI Number | 1467450718
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Entity Type | Organization
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Legal Business Name | VISITING NURSE ASSOCIATION OF THE MOTHER LODE
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Dates
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Enumeration Date | 07/11/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 20100 CEDAR RD N
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City | SONORA
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State | CA
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Zip | 95370-5957
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Country | US
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Telephone | 209-533-6800
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Fax |
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Provider Business Mailing Address
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Address Line | 20100 CEDAR RD N P.O. BOX 4805
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City | SONORA
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State | CA
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Zip | 95370-5957
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Country | US
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Telephone | 209-533-6800
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Fax |
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Authorized Official
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Title or Position | FISCAL SUPERVISOR
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Name | DEBORAH ANN MONTGOMERY
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Credential |
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Telephone | 209-533-6839
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State | CA
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